Individual
DR. IVAN BRUCE BANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D. ,F.A.A.O.
Contact information
Practice address
8611 HILLCREST AVE, STE. 140, DALLAS, TX 75225-4207
(214) 739-8611
(214) 739-8612
Mailing address
8611 HILLCREST AVE, STE. 140, DALLAS, TX 75225-4207
(214) 739-8611
(214) 739-8612
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
03313TG
TX
152WC0802X
Corneal and Contact Management Optometrist
930-108T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2264B
BLUE CROSS BLUE SHIELD
LA
01
—
721030686BA
HUMANA
LA
01
—
83020
COVENTRY HEALTHCARE
LA
Enumeration date
11/09/2005
Last updated
01/10/2015
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